Q&A: Representative Andrea Salinas discusses lowering payer costs and covering all Oregonians
Representative Andrea Salinas represents House District 38, which is Lake Oswego and Southwest Portland. She formerly served as the chair of the House Committee on Health Care and now serves as the vice-chair for that committee. She is busy advocating to lower the overall costs on payers for health insurance and is working to provide accessible health insurance to all Oregon residents.
In this Q&A, Representative Salinas talks to State of Reform about her efforts to make these things happen and how her success has been in the House Committee of Health Care and throughout this legislative session so far.
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PJ: What are a few of the most important pieces of health care legislation going through the session right now?
AS: In terms of the House Health Care Committee, I think we need to continually look at how folks are accessing care or, I should say, not accessing care. We still have about 6% of Oregonians who lack any kind of access to health insurance, which means that they don’t really have a formal way to access care. That doesn’t include the underinsured, or for those whose deductibles, co-pays, cost share and out-of-pocket expenses are too high. So they’re not accessing care. Something that I’m working on right now is looking at a public option. Given what’s happening with the Feds and with American Rescue Plan Act (ARPA), I think that will put a new wrinkle in all of this as well. So it’s unclear whether the marketplace and their expansion of the marketplace will cover folks indefinitely or for a short period of time.
PJ: Tell me about your efforts to lower overall health care costs for Oregonians.
AS: As we know, our premiums on the marketplace have increased exponentially since 2013, when we first introduced the marketplace here in Oregon. So we have to bring the cost of that down. So something that the legislature and I are working on is the cost growth benchmark target. It looks at what we should peg our rate of growth across all payers, all providers and all systems in Oregon. A workgroup worked all summer last year, and it was a pretty large group, bringing together payers, providers and all different systems. They came to the 3.4% cost growth target. House Bill 2081 will be an important bill. I do think it will be partisan since it left the committee on a party line vote. Again, we’re not going to be able to address costs for consumers if we don’t start to address cost in the system.
I also have HB 2362, which looks at mergers, acquisitions and affiliations. So before these consolidations happen, we have to know how it will affect consumers. Are cost savings from these consolidations getting out to consumers? Or, is it going to be a venture capital kind of investment, where the savings go back out to investors? It asks the Department of Consumer and Business Services (DCBS) and Oregon Health Authority (OHA) to take a closer look at those types of mergers and acquisitions. There will be thresholds for the type of revenue that these entities bring in initially. If there is something that is an emergency, and you have to keep the lights on, there’s consideration for that because we know that not all consolidations are bad. A lot of times it is to make sure that we have providers in certain areas. So if there’s a provider in a rural area that needs help, we wouldn’t want to prevent someone from coming in and helping them keep the lights on. There will be an outside body called the Oversight Review Board to provide input to OHA, and no more than a third of industry health executives can make up that board. It has to be from consumer groups, stakeholders and community advocates. We want to hear from consumers and try to figure out how any kind of merger or affiliation is going to affect them and their access to services. Often, when Catholic entities will consolidate with other non-Catholic entities, we lose services like abortion care. There is limited reproductive health service out there already. Women typically go into the Willamette Valley just to get like a pap smear. So, I think as these mergers and acquisitions continue to happen because of COVID, we’re going to be seeing more of them. Now is the time to put a magnifying glass on what’s happening because we are not seeing the savings from these going back out to consumers. The savings are staying within the systems and I think corporate entities are seeing these savings. Before we try to expand access or move to any kind of public option or single payer, we need to figure out how we reduce costs.
PJ: So are there any other bills that you think are timely and necessary that you’re working on?
AS: Yeah, there is. We’re calling it Cover All People and it will extend Medicaid/OHP (Oregon Health Plan) access for undocumented people. That is a large share of that last 6% of [uninsured] Oregonians. From Cover All Kids, kids age out at 19. So, from age 19 to 26, they are uninsured. Representative Campos’ bill just covers everybody. I would love to see everybody covered. I think avoiding the emergency room and being able to have a primary care doctor is helpful so you don’t have small issues turn into large problems that you’d suddenly need acute treatments for in the ER.
PJ: What challenges do you expect to come across when advocating for these bills and pushing them through the session?
AS: I think folks feel like they’ve had a lot on their plate through COVID, and I get that. So there’s a lot of opposition to what we’re trying to do, but we’ve also seen the curtains pulled back on all of the suffering and the health disparities that have gone on. So, you can’t ignore it now. We have to address it. I consider the cost growth target and mergers and acquisitions part of this as well. I feel like insurers are sitting on a lot of money. They weren’t paying out during the pandemic and people weren’t going to the doctors. The same goes for hospitals. Even though some of our hospital systems were in dire straits, there were others that weren’t faring as poorly. We just need to come clean on moving forward to do right by patients. Let’s figure out how we bring real care to patients and make healthcare less of a business and get back to that idea around care. I think these bills will do that.
This interview was edited for clarity and length